2006 Log Cabin - Illinois Membership Form

Please print this page, complete and mail this form to:

Please make all checks payable to: Log Cabin Republicans -Illinois.

Name(s)_________________________________________________________

Address_________________________________________________________

City,State,Zip____________________________________________________

Phone___________________________________________________________

Email___________________________________________________________

Voting Membership Levels (circle one)

• General Membership: $65-$249
• Bronze Level Donor: $250-$499
• All of the benefits of General Members
• A lapel pin indicating Bronze level support
• Listed as Bronze Level Donor in the LCR-Illinois Annual Dinner program
• One reserved seat at the LCR-Illinois Annual Dinner
• Silver Level Donor: $500-$999
• All of the benefits of General Members
• A lapel pin indicating Silver level support
• Listed as Silver Level Donor in the LCR- Illinois Annual Dinner program
• Two reserved seats at the LCR-Illinois Annual Dinner
• Gold Level Donor: $1,000-$2499
• All of the benefits of General Members
• A lapel pin indicating Gold level support
• Listed as Gold Level Donor in the LCR-Illinois Annual Dinner program
• Four reserved seats at the LCR-Illinois Annual Dinner
• Special Guest recognition at the LCR-Illinois Annual Dinner
• Platinum Level Donor: $2,500+
• All of the benefits of General Members
• A lapel pin indicating Platinum level support
• Listed as Platinum Level Donor in the LCR-Illinois Annual Dinner program
• One reserved table (8 seats) at the LCR- Illinois Annual Dinner
• Special Guest recognition at the LCR- Illinois Annual Dinner
• VIP reception with the Board of Directors (and special guests) prior to the LCR- Illinois Annual Dinner